Thursday, May 31, 2012

It Looks To Me That Clinician Support For The NEHRS Is Fast Ebbing Away. Government Really Isn’t Trying.

Last week saw a lot of reports regarding clinicians and their involvement in the NEHRS (PCEHR).
Importantly we had a formal release on the matter from the President of the College of GPs (RACGP).

The personally controlled electronic health record (PCEHR) – decision time approaching for general practitioners and practices

As general practitioners (GPs), every day we see patients falling through the cracks in our fragmented health system. As GPs working in primary care we understand better than any other healthcare sector that without improvements in e-health and medical information management systems we will continue to see our patients exposed to unnecessary risks, including adverse events and medication errors. That is why to date the College has been strongly supportive of the development of a shared electronic medical record.
A shared electronic medical record has the potential to improve our patients’ health outcomes and their experience of the healthcare system.
Savings to the health system will be achieved through a shared electronic medical record. These savings will be achieved from better medicines management and through reduced unnecessary duplication of tests and referrals. Our Health Minister has described it as, “a long-term return of $11 billion for a government investment which includes around $465 million over the last two years, and another $233 million in the next two”[1].
However, the international experience is clear that for general practice, the implementation is often costly and takes time, training and infrastructure investment. e-health is a long term strategy and must be funded to succeed.
We are now only a matter of weeks away from the roll out of the PCEHR across Australian general practices. From July anyone seeking healthcare, anywhere in Australia, can register for a PCEHR.
A national e-health record system requires a national approach to implementation. This is not just a technology project; it is a program to change professional behaviour, professional practice and processes. Whilst there has been significant investment in the 12 e-health pilot sites [2], this year’s Federal Budget announcements have not adequately resourced general practice for the implementation of the PCEHR nationally. ‘Go live’ is now very close and adequate support for implementation across the thousands of Australian practices, despite heavy lobbying, has not been forthcoming.
Members will be aware of the College’s strong and consistent support for innovation and use of technology in general practice. The College has been working on standards, guidelines and support for the important role of general practice in e-health over many years. General practice is central to quality care for patients and our role in this initiative is critical. However, our members are increasingly anxious about expectations and ‘unknowns’ in participating in this initiative.
Our College has worked tirelessly to explore every avenue to appropriately support general practice in this important national initiative. Since the release of the Budget, our CEO and I have met with relevant Ministerial Advisors and appropriate Deputy Secretaries at the Department of Health and Ageing, seeking answers and commitments to better support general practice.
Members and practices must make decisions soon and the information below, I believe, summarises what is and is not known regarding the PCEHR roll out, so that practices can make an informed choice regarding their participation. To assist practices in this decision, until 1 July, we will be providing members with weekly updates via Fridayfacts on the government’s implementation of the PCEHR.
Lots more is found here:
The release then goes on to identify five key area it is not happy with

1. Clinical support for the creation and maintenance of the PCEHR

2. e-health PIP

3. On the ground support

4. Data safety / governance

5. Draft Terms and Conditions for the operation of the PCEHR

The RACGP has received the second draft of the Terms and Conditions for the use of the PCEHR by providers. Further consultation will occur and the RACGP has been informed that a ministerial advisory committee will be formed. The draft Terms and Conditions do not currently have the support of the RACGP.
Professor Claire Jackson
RACGP President
There is coverage of this release here:

RACGP wary of PCEHR roll out

22 May, 2012 Kate Cowling
Just weeks before the launch of the PCEHR, the RACGP has reaffirmed its support for a shared electronic medical record, but echoed the lingering concerns of some members.
In a memo to members, RACGP president Professor Claire Jackson says an online record would save the health system significantly, but only if a “national approach” is adopted and a few issues ironed out.
“This year’s federal budget announcements have not adequately resourced general practice for the implementation of the PCEHR nationally,” she says.
With GPs having to make important decisions ahead of the 1 July rollout, doctors have expressed concerns, she says, about the ‘unknowns’ of the record, like data security, technological support and Medicare rebate specifics.
More here:
And here:

Money woes cause GP PCEHR moans

General practitioners are increasingly worried about the looming July 1 deadline for the introduction of the personally controlled electronic healthcare record (PCEHR). Among the issues concerning them are data governance standards, along with remuneration issues associated with creating and maintaining a patient’s PCEHR.
“Members are worried about the extra workload,” Royal Australian College of General Practitioners president Professor Claire Jackson told in an interview.
“They are concerned about resourcing at a practice level, and the people power needed,” she said. “They need more than five weeks to prepare. GPs are the ones who are doing the heavy lifting in the ehealth system.”
Lots more here:
The AMA has also spoken recently of its concern - see here:
This position was made pretty clear again very recently here:

System not ready for e-Health, say GPs

Emma Connors
Doctors have called on the government to delay the roll-out of electronic health records, warning the technology is not ready and the business case for GPs is non-existent.
“We share the vision but the process and the timing is terrible. If general practices and hospitals won’t be able to use it by July 1, why this headlong rush?” said Australian Medical Association president Steve Hambleton.
“If it needs some more stimulation to get it to critical mass, then let’s do that. Otherwise we will be relying solely on individuals who are motivated and prepared to pay – and that is not going to work,” he said.
Much more here:
What I find interesting is that a month or so out from launch of a half billion e-Health program that the Government does not have the ducks lined up and have the support of clinicians who are vital to make the whole thing work.
While I understand the profession would want to optimise what it gets from its role in the NEHRS it seems to me that the Government is just going out of its way to ensure the approach it is adopting is not supported and is pretty under resourced and half baked.
Take this release:

$50 million for Medicare Locals to help rollout eHealth records

18 May 2012
Health Minister Tanya Plibersek today announced $50 million over two years will be made available to Medicare Locals – networks that support frontline health providers – to assist GPs and other health care providers to adopt and use the Gillard Government’s new eHealth records system.
Ms Plibersek said the funding was part of a package to support doctors and other health professionals to help rollout the new system.
“Family doctors co-ordinate healthcare for most patients, so we know they have an important role to play in the eHealth records system,” Ms Plibersek said.
“eHealth records will ensure doctors can access a patient’s medical information in one convenient online location, reducing errors and making diagnosis and treatment quicker and easier.”
Full release here:
Guess what - there are just a few under 25,000 GPs in Australia who are active so this amounts to about  $1000 per GP per year even if every cent made it to the GPs. Hardly enough to do all the support, hand holding and support that is needed.
It also seems the consumers are less than totally keen:

50% won’t sign up for PCEHR

21 May, 2012 Michael Woodhead
Six weeks away from its launch, only one in ten people have heard of the PCEHR, and 50% of consumers say they won’t sign up for it, a survey has found.
In findings to be presented at the National Medicines Symposium this week, a survey of 203 consumers found that only 9% were aware of PCEHR.
And while almost 60% agreed with the implementation of the personally-controlled electronic health records system, only 50% said they would sign up to have a PCEHR themselves.
More here:
All in all the selling of all this - as well as the inadequacy of what is being offered - is really meaning a lot of money is being wasted in my view. They are not really serious or they would be doing a lot more.

1 comment:

Anonymous said...

".... Clinician Support For The NEHRS Is Fast Ebbing Away .... "

Does that mean the TIGER TEAMS Rah Rah Rah have gone out with the tide or is their boat still afloat?